Provider Reimburse Admin (Medical Coder)

$57,456 - $98,496/Yr

Elevance Health - Roanoke, VA

Full-time - Entry Level

Remote - Roanoke, VA

11-50 employees

Insurance Carriers and Related Activities

About the position

The Provider Reimbursement Admin (Medical Coder) at Elevance Health is responsible for ensuring accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective reimbursement criteria. This role involves reviewing various medical policies, conducting research, and analyzing data to support the development and revision of reimbursement policies.

Responsibilities

• Review company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules.
• Conduct clinical research, data analysis, and identify legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Perform CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
• Coordinate research and respond to system inquiries and appeals.
• Conduct research of claims systems and system edits to identify adjudication issues and audit claims adjudication for accuracy.

Requirements

• BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience providing an equivalent background.
• American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is required.

Nice-to-haves

• Proficiency in Microsoft Word, Excel and SharePoint.
• EM Leveling audit experience preferred.
• Strong research skills and ability to perform well independently and in a team setting.
• Experience working in a production environment with short timelines is strongly preferred.
• Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.
• FACETS or WGS experience preferred.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources